INJERTOS CUBITOS Nariz AAA Rohrich 2017

COSMETIC
Free Diced Cartilage: A New Application

of Diced Cartilage Grafts in Primary and
Secondary Rhinoplasty
Christian Kreutzer, M.D.
Background: Irregularities or deformities of the nasal dorsum after hump re-
Julius Hoehne, M.D.
duction account for a significant number of revision rhinoplasties. The authors
Wolfgang Gubisch, M.D.
therefore developed a technique of meticulously dicing and exactly placing
Farid Rezaeian, M.D. free diced cartilage grafts, harvested from septum, rib, or ear cartilage. The
Sebastian Haack, M.D. cartilage paste is used for smoothening, augmentation, or camouflaging of the
Stuttgart, Germany; and Zurich, nasal dorsum in primary or revision rhinoplasties.
Switzerland Methods: A retrospective analysis of multisurgeon consecutive open approach
rhinoplasties from January to December of 2014 was conducted at a single
center. The authors compared the outcome of three different techniques to
augment or cover the nasal dorsum after an observation period of 7 months.
In group I, 325 patients with free diced cartilage grafts as the only onlay were
included. In group II, consisting of 73 patients, the dorsal onlay was either fas-
cia alone or in combination with free diced cartilage grafts. Forty-eight patients
in group III received a dorsal augmentation with the classic diced cartilage in
fascia technique.
Results: Four hundred forty-six patients undergoing primary and secondary
rhinoplasties in which one of the above-mentioned diced cartilage techniques
was used were included in the study. The authors found revision rates for dor-
sal irregularities within the 7-month postoperative observation period of 5.2,
8.2, and 25 percent for groups I, II, and III, respectively.
Conclusion: The authors’ findings strongly support their clinical experience
that the free diced cartilage graft technique presents an effective and easily
reproducible method for camouflage and augmentation in aesthetic and re-
constructive rhinoplasty. (Plast. Reconstr. Surg. 140: 461, 2017.)
I
rregularities of the nasal dorsum are regularly associated with unwanted side effects and is rarely
appearing sequelae after hump removal in aes- used in the non-Asian rhinoplasty world.2 Since
thetic rhinoplasty. Small elevations, notching, the 1990s, the use of autologous or allogenic fas-
and discrete asymmetry frequently occur. The cia has gained increasing popularity.3 In the past
problem is aggravated in thin-skin patients and decade, diced cartilage grafts in fascia were used
in secondary cases where the original anatomy is as diced cartilage in fascia for dorsal augmenta-
frequently destroyed. Free solid cartilage grafts tion.4–6 Ever since the evolution of diced cartilage
processed with a morselizer were the treatment grafts, surgeons have been searching for a scaf-
of choice for a long time. However, grafts to the fold to simplify placement and shaping of the
nasal dorsum are challenging because of their vis- coarse-grained cartilage granulate. Among other
ibility if not placed precisely. In addition, second- techniques, grafts were wrapped in autologous or
ary dislocation of large solid grafts may occur, as allogenic fascia, oxidized cellulose polymer (Sur-
well as unpredictable resorption when crushed gicel; Ethicon, Inc., Somerville, N.J.), or acellular
to fit in place.1 Alloplastic material, in contrast, is dermal matrix (AlloDerm; LifeCell Corp., Branch-
burg, N.J.).5,7,8 Other published approaches dem-
From the Department of Facial Plastic Surgery, Marienhos- onstrate the agglutination of the cartilage pieces
pital Stuttgart; and the Department of Plastic Surgery and
Hand Surgery, University Hospital of Zurich.
Received for publication October 19, 2016; accepted Disclosure: The authors have no financial interest
February 8, 2017. in any of the products or devices mentioned in this
Copyright © 2017 by the American Society of Plastic Surgeons article. No funding was received for this article.
DOI: 10.1097/PRS.0000000000003622
www.PRSJournal.com 461
Copyright © 2017 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Plastic and Reconstructive Surgery • September 2017
with fibrin glue9–13 or the patient’s own blood.14–16 dicing and placing diced cartilage grafts were doc-
However, scaffolds may be associated with higher umented. Our newly developed preparation and
costs, longer operating time, and increased com- application technique of free diced cartilage was
plication rates such as infections and unpredict- compared to classic techniques using fascia with
able graft resorption. Consequently, the aim of or without diced cartilage grafts. In all cases, the
our study was to develop a new way of preparing application to the nasal dorsum for smoothening,
cartilage grafts to supersede the use of scaffolds, augmentation, and camouflage was evaluated.
to ease the placement and shaping of the graft, Accordingly, patients included in the study were
and to increase its viability. In the present study, divided into three groups (groups I, II, and III).
we present our method of meticulously dicing In 325 cases, free diced cartilage was applied
and placing free diced cartilage harvested from onto the nasal dorsum, either for augmentation
septum, rib, or ear cartilage to smoothen, aug- or for coverage of irregularities (group I). Two
ment, or camouflage the nasal dorsum in primary hundred twelve cases (65.23 percent) were pri-
and revision rhinoplasties. mary, and 113 (34.77 percent) were secondary
operations. The mean age at the time of surgery
PATIENTS AND METHODS in group I was 33 ± 12.63 years (range, 14 to 73
years).
This study was approved by the appropriate
In group II, 73 patients [48 (65.75 percent)
institutional and national research ethics com-
primary and 25 (34.25 percent) secondary cases]
mittee and was performed, including all proce-
were included, and mean age at the time of sur-
dures, in accordance with the ethical standards
gery was 34 ± 12.63 years (range, 17 to 69 years).
laid down in the 1964 Declaration of Helsinki. All
Twenty-four patients (33 percent) received fascia
participants gave their informed consent in writ-
ing before inclusion in the study, specifically for only and 49 patients (67 percent) received fascia
publication of photographs. in combination with free diced cartilage. In 71
A retrospective analysis of multisurgeon con- cases, allogenic fascia lata (Tutoplast; Tutogen
secutive rhinoplasties including the use of diced Medical GmbH, Neunkirchen am Brand, Ger-
cartilage grafts was conducted at a single institu- many) was used, and two patients received autolo-
tion. From January of 2014 through December of gous deep temporal fascia.
2014, 488 primary and secondary open approach In group III, only diced cartilage in fascia
rhinoplasties were performed by five different was used. We included 48 patients [17 primary
senior surgeons. Forty-two patients (9.38 percent) (35.42 percent) and 31 (64.58 percent) secondary
could not be examined 7 months postoperatively cases], with a mean age of 34 ± 11.84 years at the
and were considered lost to follow-up. Therefore, time of surgery (range, 17 to 53 years). Twenty-
446 patients (270 female and 176 male patients) four patients (50 percent) patients received allo-
were included in the current study, of which 277 genic fascia lata (Tutoplast), whereas 24 patients
(62.11 percent) underwent primary rhinoplasty (50 percent) received autologous deep tempora-
and 169 (37.89 percent) had undergone at least lis fascia. Means and standard deviations were cal-
one previous rhinoplasty. Fifty-six percent of culated using Excel (Microsoft Corp., Redmond,
patients had thin skin, 21 percent had intermedi- Wash.).
ate skin, and 23 percent had thick skin, based on
the surgeon’s preoperative evaluation. Surgical Technique
Thirty-eight patients (8.52 percent of all Cartilage is harvested without perichondrium
patients included in the study) presented with a from the nasal septum, the concha or tragus of
congenial or nontraumatic deformity such as cleft the ear, or the rib. Subsequently, it is diced into
nose, Binder syndrome (maxillonasal dysplasia), pieces smaller than 0.2 mm in diameter, thereby
Wegener granulomatosis, or Marfan syndrome. differing from the originally larger size described
All patients included in the study were seen and by Daniel and Calvert.5 For cutting, a sharp derma-
physical examination was performed according tome blade is used like a chopping knife (Fig. 1).
to our standard protocol 7 months postopera- During the dicing process, small amounts (1 to
tively. At this point, the indication for revision sur- 3 ml) of normal saline or gentamicin solution
gery was set if dorsal irregularities were present. cause an adhesive effect through surface tension.
Patients’ medical records and photographs were To maintain viability of the chondrocytes, it is
reviewed, and a history of previous operations, the important not to squeeze the cartilage during the
donor site of the cartilage, and the technique of cutting process. Finally, a fine-particle free diced
462
Volume 140, Number 3 • Free Diced Cartilage in Rhinoplasty
Fig. 1. Preparation of the free diced cartilage with a dermatome

blade.
cartilage granulate is fabricated, featuring charac-

teristics of a shapable paste (Fig. 2). The applica-
tion of the paste can be performed in two ways:
it can either be put onto a Freer raspatory and
thus be placed to the relevant region under direct
vision (Fig. 3, above); or, as in most cases, it can be
applied after redraping the skin flap and sutur-
ing the transcolumellar incision. For this purpose,
the free diced cartilage paste is filled into a 1-ml
syringe (Fig. 3, center), dried (Fig. 3, below), and
finally injected directly into the relevant region
(Fig. 4). Having applied free diced cartilage to the
nasal dorsum, we massage and immediately fixate
it with paper drape. At the end of the procedure,
a cast stabilizes the result. Every irregularity and
even the smallest dimplings can be filled up with
free diced cartilage to create a smooth contour of
the dorsum of the nose.
Fig. 3. (Above) Direct application with a Freer raspatory. (Center)

Filling of the syringe with diced cartilage. (Below) Squeezing out
the sodium chloride solution.
RESULTS
Of 325 patients undergoing primary or sec-
ondary rhinoplasty from January of 2014 through
December of 2014 with free diced cartilage applied
onto the nasal dorsum (group I), 30 patients (9.2
percent) were scheduled for revision surgery 7
months postoperatively. In group II, consisting of
73 patients undergoing primary or secondary rhi-
noplasty with fascia alone or in combination with
free diced cartilage during the same period, seven
Fig. 2. Diced cartilage before filling of the syringe. patients (9.6 percent) were scheduled for revision
463
overall revision rate of 5.2 percent for problems

associated with the nasal dorsum in this group.
Nine of the revisions for dorsal irregularities were
performed in the subgroup of the 212 primary
cases (4.25 percent), whereas eight of the revi-
sions were performed in the subgroup of the 113
secondary cases (7.08 percent).
In group II, six of seven revisions were per-
formed because of persisting dorsal irregularities
or deformities, yielding a revision rate of 8.2 per-
cent for problems with the nasal dorsum. Five of
the revisions were performed in the subgroup of
the 48 primary cases (10.42 percent), whereas one
revision was performed in the subgroup of the 25
secondary cases (4.00 percent). Only one revision
operation was performed in the fascia-only sub-
group, whereas five revisions were performed in
the subgroup in which fascia in combination with
free diced cartilage was applied.
Of 15 revision operations conducted in group
III, 12 cases were caused by dorsal irregularities or
deformities, resulting in a revision rate of 25 per-
cent for dorsal irregularities or deformities in this
group. Three of the revisions were performed in
the subgroup of the 17 primary cases (17.65 per-
cent), and nine of the revisions were performed
in the subgroup of the 31 secondary cases (29.03
percent).
Revision surgery because of persistent dorsal
irregularities was recommended but refused by
an additional two patients from group I, and by
one additional patient from group II. All patients
for whom revision surgery was recommended
from group III underwent surgery. Apart from
dorsal irregularities and deformities, indications
for revision surgery in all groups included inad-
equate rotation or projection of the nasal tip
(n = 8), persisting functional problems (n = 3),
postoperative alar retraction or deformity (n = 3),
Fig. 4. (Above) Intraoperative side view before injection of the and others (n = 3).
free diced cartilage. (Center) Syringe on the nasal dorsum for
free diced cartilage application. (Below) Side view after augmen-
CASE REPORTS
tation with the free diced cartilage.
Case 1
surgery 7 months postoperatively. Of 48 patients A 41-year-old woman presented with a devi-
included in group III, receiving diced cartilage in ated nose and a high nasal dorsum (Figs. 5, left,
fascia for dorsal augmentation or coverage of dor- and 6, left). She had undergone previous rhino-
sal irregularities in the same period, 15 patients plasty and suffered from severe breathing prob-
(31.3 percent) were scheduled for revision sur- lems. Endonasal examination revealed a severe
gery 7 months after surgery. septal deviation to the left and hypertrophy of the
Subgroup analysis of reasons for revision right inferior turbinate. The nasal skin was thin.
showed that in group I, 17 of the 30 revision Surgical Steps
operations were performed because of persisting Open approach revision rhinoseptoplasty
dorsal irregularities or deformities, yielding an included the following:
464
Fig. 5. Case 1. (Left) Frontal view preoperatively. (Right) Frontal view 7 months
postoperatively.
Fig. 6. Case 1. (Left) Profile view preoperatively. (Right) Profile view 7 months
postoperatively.
1. Straightening of the septum. 6. Reconstruction of the tip support with colu-

2. Lowering of the nasal dorsum using compo- mellar strut.
7. Augmentation of the nasion with free diced
nent reduction.
cartilage plus smoothening of dorsal irregu-
3. Paramedian, low-to-low lateral and trans- larities with free diced cartilage.
verse osteotomies.
Postoperative follow-up revealed midline sag-
4. Spreader flaps to open the inner nasal valve.
ittal realignment of the nose in bony and cartilagi-
5. Tip refinements with domal and interdomal nous parts 7 months postoperatively. A straight
sutures and spanning suture. profile with stable augmentation of the nasion
465
could be seen (Figs. 5, right, and 6, right). Marked Preoperative examination revealed a free nasal air-
functional improvement was also achieved. way and a straight septum. However, a step was seen
at the reconstructed bone/cartilage junction with
Case 2 an elevation in the bony part and an indentation in
the cartilaginous part (Figs. 7, left, and 8, left).
A 25-year-old man presented with dorsal irreg-
ularities after three previous rhinoplasties, includ- Surgical Steps
ing septal reconstruction with rib cartilage and Open approach revision rhinoplasty included
dorsal augmentation with diced cartilage in fascia. the following:
postoperatively.
postoperatively.
466
1. Rasping of the bony part. breathing impairment. She related a trauma to

2. Harvesting of conchal cartilage of the right ear. the nose during childhood. Clinical examination
3. Smoothening of the dorsum with free diced showed a septal deviation to the right with an
cartilage. anterior deviation to the left. Both inferior turbi-
Seven-month follow-up revealed a straight and nates were hypertrophic. The profile view showed
smooth nasal dorsum. Mild supratip fullness was an underprojected nasion. The tip was broad
acceptable to the patient (Figs. 7, right, and 8, right). and undefined, and a narrow midvault was seen
(Figs. 9, left, and 10, left).
Case 3 Surgical Steps
A 24-year-old woman presented with a devi- Open approach rhinoseptoplasty included
ated nose with a dorsal hump, complaining of the following:
postoperatively.
postoperatively.
467
1. Straightening of the septum. nasal dorsum,15 whereas Codazzi et al. pay special
2. Dorsal reduction using component attention to the blood temperature as the activ-
reduction. ity of the coagulation factors is reduced at lower
3. Widening of the inner nasal valve with temperatures.16 Both techniques avoid time-con-
spreader grafts. suming preparation of tissue glue or harvesting of
4. Submucous resection of the inferior a wrapping fascia. In addition, without wrapping
turbinates. material, revascularization may be quicker, and
5. Reconstruction of the tip support with a col- erythema and inflammation may be minimal.
umellar strut and tip suspension with ante- Bullocks et al. use autologous tissue glue to
rior sling. stabilize diced cartilage grafts,13 thereby produc-
6. Tip rotation, cephalic trim of lower lateral ing a malleable diced cartilage construction. In
cartilages, dome sutures, rim grafts. agreement with the aforementioned authors, they
7. Augmentation of the nasion and smoothen- see the advantage that there is no barrier to pre-
ing of the dorsum with free diced cartilage. vent the diffusion of nutrients to the chondrocytes
in the graft, with the result being better cartilage
One year postoperatively, the patient reported viability. As they use bovine thrombin, however,
a marked functional improvement. The profile possible side effects are immune-mediated coagu-
was straight with a stabile augmentation of the lopathy and temporary erythema of the nose fol-
nasion. A slight deviation of the nasal axis could lowing the insertion of the diced cartilage graft
still be seen (Figs. 9, right, and 10, right). with autologous tissue glue.
Regarding the viability of cartilage grafts,
there are currently contradicting results. Fatemi
DISCUSSION et al. found statistically significant resorption of
Most rhinoplasty procedures affect the nasal diced cartilage grafts wrapped in fascia in their
dorsum,17 which plays a key role in both nasal form experimental study, whereas solid block cartilage
and nasal function. Hump reduction with subse- grafts wrapped in fascia showed no statistically
quent widening of the bony dorsum and recon- significant resorption rate.19 In contrast, Brenner
struction of the internal nasal valves by spreader et al. showed that wrapping diced cartilage with
flaps or grafts causes changes, especially in the fascia confers higher chondrocyte viability associ-
bone/cartilage junction, and irregularities that ated with long-term permanence, making it the
need to be smoothened occur regularly. In our first choice when significant volume replacement
daily work, we often deal with patients presenting is needed in the nasal dorsum.20
with unsatisfying results after one or several previ- In the current study, we introduce our newly
ous operations, asking for improvements. An over- developed modification of the Daniel technique
resected framework with mild or moderate dorsal called free diced cartilage, enabling the surgeon
depression or even severe saddle nose deformity to use a diced cartilage mass as spackling com-
is common. According to Yu et al., upper third pound to fill irregularities in almost every region
dorsal irregularities are the third most frequent of the nose, especially the dorsum. Using the free
problem among patients looking for aesthetic diced cartilage technique alone for smoothen-
improvement and the second most frequent sur- ing the nasal dorsum, we found revision rates for
geon finding.18 Even experienced rhinoplasty dorsal irregularities during the 7-month postop-
surgeons are confronted with the complexity of erative follow-up examination of 5.2 percent. In
these problems, which remain a challenging topic contrast, when fascia alone or in combination
in primary and revision rhinoplasty. To manage with free diced cartilage was used to treat irregu-
the challenges of the nasal dorsum, several tech- larities of the nasal dorsum, we observed revision
niques including a wide range of different grafts rates of 8.2 percent. The use of diced cartilage
and implants have been described.17 in fascia was associated with the highest revision
In the Tasman technique, and in the tech- rate (25 percent) in the current study. These find-
nique described by Bracaglia et al., fibrin glue ings strongly support our clinical experience that
is used for coherence of small cartilage pieces the free diced cartilage technique is an effective
before delivering it to the nasal dorsum,9–11,14 method for camouflage and augmentation of
thereby avoiding dispersion of fragments and pro- the nasal dorsum in both primary and secondary
viding ease of molding. Öreroğlu et al. describe a rhinoplasty.
way of delivering a bone dust and diced-cartilage Advantages of the free diced cartilage tech-
mixture with addition of the patient’s blood to the nique are the virtually limitless availability of
468
grafting material and a low donor-site morbidity. CONCLUSIONS

Being autologous material mainly harvested from Free diced cartilage processed and used
septal, costal, or conchal/tragal cartilage, no according to our new protocol presents an effective
rejection was observed in our study. and easily reproducible method for camouflage
In comparison to the above-mentioned tech- and augmentation in aesthetic and reconstructive
niques using the patient’s blood, bone dust, or rhinoplasty and should have a permanent place
fibrin glue, the permanent volume being added among techniques available to the rhinoplasty
can be estimated much more precisely when using surgeon. However, because of the relatively short
free diced cartilage. Moreover, the production and postoperative observation period in the current
application of free diced cartilage is quicker and study, the results should be considered prelimi-
easier, thereby saving precious operating time. It nary and further studies should be performed to
can be combined with allogenic or autologous evaluate long-term results.
fascia; however, being a fine granulate, free diced
cartilage can be used without any bonding mate- Julius Hoehne, M.D.
Department of Facial Plastic Surgery
rial, making it a highly cost-effective technique. Centre of Plastic Surgery
In our institution, free diced cartilage is Marienhospital Stuttgart
mainly applied at the end of the operation by Böheimstrasse 37
either direct positioning under visual control 70199 Stuttgart, Germany
using a Freer raspatory, or injected after skin clo- hoehne.julius@gmail.com
sure through the open infracartilaginous inci-
sions with a syringe. Using this technique, we did
PATIENT CONSENT
not observe any dislocation of the graft on clinical
examination during the 7-month follow-up period Patients provided written consent for the use of their
in our series, rendering the use of additional scaf- images.
folds redundant.
Another advantage of our technique is the
REFERENCES
plasticity of the fine granulated free diced carti-
1. Cakmak O, Buyuklu F. Crushed cartilage grafts for con-
lage mass, enabling a large variety of shapes, and cealing irregularities in rhinoplasty. Arch Facial Plast Surg.
allowing the graft to perfectly fit in various recipi- 2007;9:352–357.
ent sites of the nose. However, correct handling 2. Winkler AA, Soler ZM, Leong PL, Murphy A, Wang TD,
and application of the free diced cartilage is cru- Cook TA. Complications associated with alloplastic implants
cial, and intraoperative swelling has to be taken in rhinoplasty. Arch Facial Plast Surg. 2012;14:437–441.
3. Gubisch W. Implants in rhinoplasty: Value and indications
into account to avoid unwanted overcorrection or (in German). Handchir Mikrochir Plast Chir. 1992;24:38–45.
undercorrection. Furthermore, free diced carti- 4. Daniel RK, Sajadian A. Secondary rhinoplasty: Management
lage may be an ideal smoothening or augmenta- of the overresected dorsum. Facial Plast Surg. 2012;28:417–426.
tion graft and can even be used in combination 5. Daniel RK, Calvert JW. Diced cartilage grafts in rhinoplasty
with diced cartilage in fascia for “fine-tuning” of surgery. Plast Reconstr Surg. 2004;113:2156–2171.
6. Kelly MH, Bulstrode NW, Waterhouse N. Versatility of diced
transition zones between diced cartilage in fascia cartilage-fascia grafts in dorsal nasal augmentation. Plast
and the nasal dorsum, but does not replace struc- Reconstr Surg. 2007;120:1654–1659; discussion 1654–1659.
tural grafts like diced cartilage in fascia. Accord- 7. Erol OO. The Turkish delight: A pliable graft for rhino-
ing to our data, however, diced cartilage in fascia plasty. Plast Reconstr Surg. 2000;105:2229–2241; discussion
grafts should only play a role in cases where a 2242–2243.
8. Gryskiewicz JM, Rohrich RJ, Reagan BJ, Schwartz BM. The
larger amount of augmentation is required, as use of AlloDerm for the correction of nasal contour deformi-
revision rates are high because of dislocations ties. Plast Reconstr Surg. 2001;107:571.
of the graft. This is partly because of the higher 9. Baker SR. Diced cartilage augmentation: Early experi-
number of “severe” secondary cases in the diced ence with the Tasman technique. Arch Facial Plast Surg.
cartilage in fascia group in the current study, as 2012;18:1–5.
10. Tasman AJ. Advances in nasal dorsal augmentation with

subgroup analysis showed nearly doubled revision diced cartilage. Curr Opin Otolaryngol Head Neck Surg.
rates for secondary cases compared to primary 2013;21:365–371.
cases in the free diced cartilage–only and the 11. Tasman AJ, Diener PA, Litschel R. The diced cartilage glue
diced cartilage in fascia groups. However, at least graft for nasal augmentation: Morphometric evidence of
in our hands, there are undoubtedly technical dif- longevity. JAMA Facial Plast Surg. 2013;15:86–94.
12. Kelly MH, Bulstrode NW, Waterhouse N. Versatility of

ficulties associated with permanently keeping the diced cartilage-fascia grafts in dorsal nasal augmenta-
graft in a proper position using the diced cartilage tion. Plast Reconstr Surg. 2007;120:1654–1659; discussion
in fascia technique. 1654–1669.
469
13. Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E. A novel 17. Lee MR, Unger JG, Rohrich RJ. Management of the nasal
autologous scaffold for diced-cartilage grafts in dorsal aug- dorsum in rhinoplasty: A systematic review of the literature
mentation rhinoplasty. Aesthetic Plast Surg. 2011;35:569–579. regarding technique, outcomes, and complications. Plast
14. Bracaglia R, Tambasco D, DʼEttorre M, Gentileschi S.
Reconstr Surg. 2011;128:538e–550e.
“Nougat graft”: Diced cartilage graft plus human fibrin 18. Yu K, Kim A, Pearlman SJ. Functional and aesthetic concerns
glue for contouring and shaping of the nasal dorsum. Plast of patients seeking revision rhinoplasty. Arch Facial Plast Surg.
Reconstr Surg. 2012;130:741e–743e. 2010;12:291–297.
15. Öreroğlu AR, Çakır B, Akan M. Bone dust and diced car- 19. Fatemi MJ, Hasani ME, Rahimian S, Bateni H, Pedram M, Mousavi
tilage combined with blood glue: A practical technique for SJ. Survival of block and fascial-wrapped diced cartilage grafts: An
dorsum enhancement. Aesthetic Plast Surg. 2014;38:90–94. experimental study in rabbits. Ann Plast Surg. 2012;69:326–330.
16. Codazzi D, Ortelli L, Robotti E. Diced cartilage combined 20. Brenner KA, McConnell MP, Evans GRD, Calvert JW. Survival
with warm blood glue for nasal dorsum enhancement. of diced cartilage grafts: An experimental study. Plast Reconstr
Aesthetic Plast Surg. 2014;38:822–823. Surg. 2006;117:105–115.
470

INJERTOS CUBITOS Nariz AAA Rohrich 2017

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

INJERTOS CUBITOS Nariz AAA Rohrich 2017

Uploaded by

Copyright:

Available Formats

COSMETIC

Free Diced Cartilage: A New Application

Fig. 1. Preparation of the free diced cartilage with a dermatome

cartilage granulate is fabricated, featuring charac-

Fig. 3. (Above) Direct application with a Freer raspatory. (Center)

overall revision rate of 5.2 percent for problems

1. Straightening of the septum. 6. Reconstruction of the tip support with colu-

1. Rasping of the bony part. breathing impairment. She related a trauma to

grafting material and a low donor-site morbidity. CONCLUSIONS

You might also like